Citation Nr: 21068342 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 12-28 616 DATE: November 10, 2021 ORDER An initial compensable rating for otitis externa is denied. An initial compensable rating for anemia from August 27, 2009 to December 8, 2018 is denied. An initial rating higher than 10 percent for anemia since December 9, 2018 is denied. An initial compensable rating for type II herpes simplex is denied. Service connection for myalgia and myositis is denied. Service connection for sinusitis is denied. Service connection for vaginitis candida albicans is denied. Service connection for migraine headaches is granted. FINDINGS OF FACT 1. The record evidence shows that the Veteran's service-connected otitis externa was not manifested by frequent and prolonged treatment during the appeal period. 2. From August 27, 2009 to December 8, 2018, the Veteran's anemia was not manifested by hemoglobin levels of 10gm/100ml or less with findings such as weakness, easy fatigability, or headaches. 3. Since December 9, 2018, the Veteran's anemia has not manifested by hemoglobin levels of 8 gm/100ml or less with findings such as weakness, easy fatigability, headaches, lightheadedness, or shortness of breath. 4. The evidence does not that the Veteran's HSV covered at least 5 percent of her entire body or exposed skin or was treated with intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs. 5. The Veteran does not have myalgia and myositis disability related to service. 6. The Veteran does not have a current sinusitis disability related to service. 7. The Veteran does not have vaginitis candida albicans disability related to service. 8. The Veteran has a current migraine disability related to service. CONCLUSIONS OF LAW 1. The criteria for an initial compensable rating for otitis externa have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.87, Diagnostic Code (DC) 6201-6210. 2. From August 27, 2009 to December 8, 2018, the criteria for entitlement to an initial compensable rating for anemia have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.117, Diagnostic Code 7700 (2018), 7720. 3. Since December 9, 2018, the criteria for a rating higher than 10 percent for anemia have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.117, Diagnostic Code 7700 (2018), 7720. 4. The criteria for entitlement to an initial compensable rating for type II herpes simplex were not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.1-4.14, 4.118, Diagnostic Code 7806. 5. The criteria for service connection for myalgia and myositis have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for service connection for sinusitis have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for service connection for vaginitis candida albicans have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for service connection for a migraine disability have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 2001 to August 2009. The claims were remanded for further development in a May 2018 Board decision. While on remand, the RO granted entitlement to service connection for posttraumatic stress disorder with major depressive disorder with mood congruent psychotic features (claimed as attention deficit hyperactivity disorder and as adjustment disorder with anxiety, depressed mood and insomnia). As this constitutes a full grant of the benefits sought, this issue is no longer on appeal. AB v. Brown, 6 Vet. App. 35 (1993). The Veteran was also granted a higher rating for anemia to 10 percent disabling since December 9, 2018. The grant does not constitute a full grant of benefits sought thus the claim is still on appeal before the Board. Id. Higher Rating Disability ratings are based upon VA's Schedule for Rating Disabilities as set forth in 38 C.F.R. Part 4. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity in civil occupations. 38 U.S.C. § 1155. The disability must be viewed in relation to its history. 38 C.F.R. § 4.1. A higher evaluation shall be assigned where the disability picture more nearly approximates the criteria for the next higher evaluation. 38 C.F.R. § 4.7. In any claim for an increased rating, "staged" ratings may be warranted where the factual findings show distinct time periods when the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119 (1999). 38 C.F.R. § 4.7. It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. 1. Entitlement to an initial compensable rating for otitis externa. The Veteran claims entitlement to an increased evaluation for her service-connected chronic otitis externa. The Veteran's chronic otitis externa is rated under 38 C.F.R. § 4.87, DC 6210. Under DC 6210, a maximum 10 percent rating is assigned for swelling, dry and scaly or serous discharge, and itching requiring frequent and prolonged treatment. See 38 C.F.R. § 4.87, DC 6201-6210. The claim was remanded for further development in May 2018. A December 2018 treatment note shows the Veteran denied ear discharge and clear canals, drums, and TMs. A March 2019 Ear Conditions Disability Benefits Questionnaire documented the Veteran's symptoms of swelling, and increased infections in the left ear. The Veteran was diagnosed with chronic otitis media, status post TM perforation. The Veteran reported that she has had recurrent ear pain and ear infections for almost 20 years, requiring antibiotic oral medication and ear drops. Her treatment plan did not include taking continuous medication for the condition. Upon examination of the ear, nose, and throat, the examiner found that the externals ears to be normal, the ear canal to be normal, and evidence of left tympanic membrane perforation and sclerosed left TM. The Veteran's gait, Dix Hallpike test, and limb coordination test were normal. The examiner documented symptoms of swelling inferior to the left ear, and right and left ear pain associated with infections. There was also a significant amount of ear wax from left ear. The examiner noted that the functional impact of the Veteran's condition is that ear infections cause her to miss work at times. An April 2020 Medical Opinion Disability Benefits Questionnaire documented the Veteran's symptoms of swelling in the left ear. The examiner also the Veteran's complaint of significant amounts of ear wax in the left ear. The examiner noted that the Veteran's condition does not require continuous medication. The Veteran's June 2021 treatment record shows left impacted cerumen completely occluding the canal, and right ear with a large amount of cerumen but not completely occluded. The Veteran complained of left ear pressure that was not painful, and that did not cause drainage. An additional treatment note documents dull, throbbing pain. Having considered the evidence of record, the Board finds that the preponderance of the evidence is against granting an initial compensable rating for the Veteran's service-connected chronic otitis externa during the appeal period. The March 2019 VA Ear Conditions examination indicated that Veteran's ear condition did not include taking continuous medication, and the evidence on record does not indicate that frequent and prolonged treatment is required. Whether a disability meets the schedular criteria for the assignment of a higher evaluation is a factual determination by the Board based on the complaints coupled with the medical evidence. Here, although the Veteran asserts that she meets the criteria for a higher disability rating, the evidence of record does not more nearly reflect the 10 percent rating under DC 6210 during the appeal period. There is no basis to stage the rating as the evidence shows no distinct period where the disability exhibited symptoms that would warrant different ratings than assigned. See Hart v. Mansfield, 21 Vet. App. (2007). The Veteran otherwise has not identified or submitted any evidence demonstrating her entitlement to an initial compensable rating for her service-connected chronic otitis externa. In summary, the Board finds that the criteria for an initial compensable rating for chronic otitis externa have not been met. 2. An initial compensable rating for anemia from August 27, 2009 to December 8, 2018 is denied. 3. An initial rating higher than 10 percent for anemia since December 9, 2019 is denied. The Veteran claims entitlement to an increased evaluation for her service-connected anemia. At the time the Veteran filed the claim, iron deficiency anemia disabilities were evaluated under Diagnostic Code (DC) 7700. On October 29, 2018, VA issued a final rule revising 38 C.F.R. § 4.117, the portion of the VA Schedule for Rating Disabilities that addresses the hemic and lymphatic systems, effective December 9, 2018. See 83 FR 54250, 54254 (Oct. 29, 2018). The final rule updated medical terminology, added certain hematologic diseases, and provided detailed and updated criteria for evaluating conditions pertaining to the hematologic and lymphatic systems. The rule removed DC 7700 (Anemia, hypochromic-microcytic and megaloblastic, such as iron-deficiency and pernicious anemia) and added separate DCs (7720-7723) for the four major types of anemia that are neither hereditary nor secondary (addressed under the diagnostic code for the causative condition). Id. When a new regulation is issued while a claim is pending before VA, unless clearly specified otherwise, VA must apply the new provision to the claim from the effective date of the change as long as the application would not produce retroactive effects. See VAOPGCPREC 7-03. Even if the amended versions are more favorable, the amended versions may only be applied as of their effective date and, before that time, only the former version of the regulation may be applied. See VAOPGCPREC 3-00; 65 Fed. Reg. 33,422 (2000); see also Kuzma v. Principi, 341 F.3d 1327, 1328-29 (Fed. Cir. 2003). Under the rating criteria in effect prior to December 9, 2018, DC 7700 provided that a 0 percent rating was warranted for anemia when the hemoglobin level was 10gm/100ml or less and the condition was asymptomatic. A 10 percent rating was warranted for a hemoglobin level of 10gm/100ml or less with findings such as weakness, easy fatigability, or headaches. A 30 percent rating was warranted for a hemoglobin level of 8gm/100ml or less, with findings such as weakness, easy fatigability, headaches, lightheadedness, or shortness of breath. A 70 percent rating was warranted for a hemoglobin level of 7gm/100 ml or less, with findings such as dyspnea on mild exertion, cardiomegaly, tachycardia (100 to 120 beats per minute) or syncope (three episodes in the last six months). A 100 percent rating was warranted for a hemoglobin level of 5gm/100ml or less, with findings such as high output congestive heart failure or dyspnea at rest, is rated 100 percent disabling. A Note to DC 7700 provided that complications of pernicious anemia, such as dementia or peripheral neuropathy, were to be rated separately. 38 C.F.R. § 4.117 (2018). The Veteran's service-connected anemia is an iron deficiency anemia. Under the rating criteria in effect from December 8, 2018, iron deficiency anemias are rated under DC 7720. Pursuant to DC 7720, iron deficiency anemia requiring intravenous iron infusions at least 1 time, but less than 4 times, per 12-month period, or requiring continuous treatment with oral supplementation, warrants a 10 percent disability rating. A 30 percent disability rating is warranted if the iron deficiency anemia requires intravenous iron infusions 4 or more times per 12-month period. 38 C.F.R. § 4.117 (2020). A December 2015 treatment note documents the Veteran's hemoglobin level as 9.6, with comprehensive metabolic profile within normal limits, with no other description of symptoms. The Veteran denied headaches and local weaknesses. An April 2017 treatment note documents the Veteran's recent blood work with a hemoglobin of 9.8. The notes did not document weakness, easy fatigability, or headaches. A November 2018 treatment note documents the Veteran's report of having a hemoglobin of "9" in September 2018. She reported that she was treated with iron in the past but was not currently on any supplement. The Veteran had a VA Hematologic and Lymphatic Conditions including Leukemia examination in March 2019. The Veteran's anemia requires her to take 325 milligrams of ferrous sulfate daily for management and impacts her ability to work in that she feels weak at times, especially when her hemoglobin is low or during menses. The Veteran also experiences weakness, easy fatigability, headaches, as well as infections at least once per year but less than once every three months. Laboratory testing measured her hemoglobin as 13.7 gm/100 ml. Under the rating criteria in effect at the time of the claim, the Veteran does not qualify for a 10 percent rating prior to December 9, 2018. While, as stated above, the Veteran's hemoglobin has been documented as below 10gm/100ml, the record does not show that the Veteran had weakness, easy fatigability, or headaches, as required for a 10 percent rating prior to December 8, 2018. See 38 C.F.R. § 4.117, DC 7700 (2018). Therefore, the Veteran does not qualify for a compensable rating under the rating criteria in effect at the time of the claim because the Veteran has not had hemoglobin 10gm/100ml or less with findings such as weakness, easy fatigability, or headaches. See id. Additionally, the record does not reflect that the Veteran had iron deficiency anemia requiring intravenous iron infusions at least 1 time, but less than 4 times, per 12-month period, or requiring continuous treatment with oral supplementation prior to December 9, 2018. A review of the record indicates that during the course of this appeal the Veteran endorsed that her anemia manifested as symptoms including headaches, weakness, and fatigability. See March 2019 VA examination. The criteria specifically include the conjunctive "with," so that these symptoms must be present in conjunction with hemoglobin levels of 10.0gm/100ml or less in order to meet the criteria for the 10 percent, or higher, schedular rating under DC 7700. See Melson v. Derwinski, 1 Vet. App. 334 (1991); compare Johnson v. Brown, 7 Vet. App. 95 (1994) (only one disjunctive "or" requirement must be met in order for an increased rating to be assigned). Therefore, the claim must be denied. Similarly, the Veteran does not qualify for a 30 percent rating since December 9, 2018. The record does not show that the Veteran's hemoglobin has been documented as 8gm/100ml with weakness, easy fatigability, headaches, lightheadedness or shortness of breath as required for a 30 percent rating since December 8, 2018. See 38 C.F.R. § 4.117, DC 7700 (2018). As the preponderance of evidence is against the Veteran's claim, the benefit-of-the-doubt rule is not applicable. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The appeal is denied. 4. Entitlement to an initial compensable rating for type II herpes simplex (HSV). The Veteran states that she is entitled to an initial compensable rating for her HSV. Disability ratings are assigned in accordance with the VA's Schedule for Rating Disabilities and are intended to represent the average impairment of earning capacity resulting from disability. See 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. Separate diagnostic codes identify the various disabilities. See 38 C.F.R. Part 4. VA published a final rule amending its regulations on skin disabilities effective August 13, 2018. The amendment, in pertinent part, added a General Rating Formula for the Skin for Diagnostic Codes 7806, 7809, 7813-7816, 7820-7822, and 7824, and amended Diagnostic Codes 7801, 7802, 7817, 7819, 7825, 7826, 7827, and 7829. See 83 Fed. Reg. 32,592 (July 13, 2018). Claims pending prior to the effective date are to be considered under both old and new rating criteria, and whichever criteria is more favorable to the Veteran will be applied. Under the regulations in effect at the time the Veteran filed her claim, Diagnostic Code 7806 provided: 0 percent rating where less than 5 percent of the entire body or less than 5 percent of exposed areas are affected, and; no more than topical therapy is required during the past 12-month period. 10 percent rating is warranted if at least 5 percent, but less than 20 percent, of the entire body, or at least 5 percent, but less than 20 percent, of exposed areas are affected, or; intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs are required for a total duration of less than six weeks during the past 12-month period. 30 percent rating is warranted if 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas are affected, or; systemic therapy such as corticosteroids or other immunosuppressive drugs are required for a total duration of six weeks or more, but not constantly, during the past 12-month period. 60 percent rating is warranted if more than 40 percent of the entire body or more than 40 percent of exposed areas affected, or; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period. 38 C.F.R. § 4.118, Diagnostic Code 7806. Under the new regulations, effective August 13, 2018, Diagnostic Code (DC) 7806 will be rated under a General Rating Formula for Skin, under which: 10 percent rating will be assigned if the disability meets at least one of the following: characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or at least 5 percent, but less than 20 percent, of exposed areas affected; or intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12-month period. 30 percent rating will be assigned if the disability meets at least one of the following: characteristic lesions involving 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. 60 percent rating will be assigned if the disability meets at least one of the following: characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required over the past 12-month period. The new regulation defines systemic therapy as treatment that is administered through any route (orally, injection, suppository, intranasally) other than the skin, and topical therapy is treatment that is administered through the skin. 38 C.F.R. § 4.118(a). The ratings schedule for each percentage of entitlement has two criteria that can be satisfied for entitlement for that rating. The first criteria are based on the percent of the body affected. Alternatively, if the affected area is not large enough, the Veteran can receive entitlement to a rating if they are receiving systemic therapy of a corticosteroid or other immunosuppressive drug as treatment for the disability. In a June 2021 statement, the Veteran indicated that she did not want to report to any C&P examinations scheduled pursuant to the May 2018 Board remand. When entitlement or continued entitlement to a benefit cannot be established or confirmed without a current VA examination or reexamination, VA regulations require specific action to be taken in accordance with 38 C.F.R. § 3.655 (b) as appropriate. 38 C.F.R. § 3.655(a). Paragraph (b) specifies that when a claimant fails to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. See also Turk v. Peake, 21 Vet. App. 565, 569 (2008). When the examination was scheduled in conjunction with any other original claim, a reopened claim for a benefit which was previously disallowed, or a claim for increase, the claim shall be denied. 38 C.F.R. § 3.655(b). The available record does not provide a basis for awarding the benefit sought, because the Veteran failed to report for her scheduled VA examination, and because this matter arises from an original compensation claim, the Board must rely on the evidence of record. 38 C.F.R. § 3.655 (a), (b). The Veteran was afforded a VA examination in March 2019for her Xerosis skin disability. The examiner referenced history of the Veteran's recurrent HSV outbreaks. The examiner noted that the Veteran did not exhibit a need for constant systemic therapy but uses near constant topical therapy for her dry skin condition which impacts less than 5 percent of her body and opined that the condition did not impact her ability to work. No further reference was made to the Veteran's HSV disability. The Veteran's treatment record, however, show that the Veteran also takes continuous medication, specifically Valacyclovir. The record does not reflect a claim by the Veteran disputing that the percentage of her entire body affected by the Herpes Simplex II is less than 5 percent and that none of the affected areas are exposed. Regarding the requirement of the use of systemic therapy, prior to August 13, 2018, the rating criteria referenced systematic treatment "such as" corticosteroids or other immunosuppressive drugs. The new rating criteria states treatment "including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs." It is noted that the use of "such as" and "including, but not limited to" demonstrate that the treatments after that phrase are not intended to constitute an exhaustive list, but rather are intended to serve as examples of the type and degree of the treatment, or their effects, that would justify a particular rating. While the new regulation includes a more expansive list, it is noted that phototherapy, retinoids, biologics, photochemotherapy, and PUVA treatments are immunosuppressive treatments. There is no dispute that the Veteran has been prescribed Valacyclovir, which is an oral antiviral medication, for the treatment of his HSV. However, no examiner has opined that the antiviral medication for HSV treatment the Veteran takes is akin to a corticosteroid or immunosuppressive agent. Upon review of the evidence of record, the Board finds that a compensable disability rating for the Veteran's service-connected herpes is not warranted. Throughout this period on appeal, the Veteran's disability has been shown to affect less than 5 percent of her entire body or exposed area, requiring no more than oral therapy that is antiviral in nature. Accordingly, as the criteria listed for a 10 percent rating under DC 7806 have not been met and a higher initial disability rating is not warranted. The Board finds that the weight of the evidence is against a higher evaluation for the Veteran's herpes simplex. As such, the benefit-of-the-doubt rule does not apply, and the claim is denied. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service." Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Certain chronic diseases, including organic diseases of the nervous system such as are presumed to be incurred in or aggravated by service if manifest to a compensable degree within one year of separation from service. See 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309(a); Fountain v. McDonald, 27 Vet. App. 258 (2015). Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 5. Service connection for myalgia and myositis. The Veteran claims entitlement to service connection for a myalgia and myositis disability. The Board remanded the claim for further development in a May 2018. In June 2021, the Veteran indicated that she did not want to report to a compensation and pension examination and requested the evaluation based on evidence of record only. As stated above, when entitlement or continued entitlement to a benefit cannot be established or confirmed without a current VA examination or reexamination, VA regulations require specific action to be taken in accordance with 38 C.F.R. § 3.655 (b) as appropriate. 38 C.F.R. § 3.655 (a). Paragraph (b) specifies that when a claimant fails to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. When the examination was scheduled in conjunction with any other original claim, a reopened claim for a benefit which was previously disallowed, or a claim for increase, the claim shall be denied. 38 C.F.R. § 3.655 (b). Thus, the claim will be evaluated based on the evidence of record. The Veteran's service treatment records show myalgia and myositis listed conditions during active-duty service. See October 2007 Service Treatment Records. The Veteran's treatment records do not show a current diagnosis for myalgia and myositis. Thus, as for element (1), the Board concludes that the Veteran does not have a current diagnosis of myalgia and myositis and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Young v. McDonald, 766 F.3d 1348 (Fed. Cir. 2014). Here, the record contains no diagnosis of a current myalgia and myositis disability by a medical professional. While the Veteran believes she has a current diagnosis of myalgia and myositis, she is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Id. Additionally, the record does not show and no examiner provided a nexus opinion that the Veteran has a current myalgia and myositis disability related to service. Given the evidence discussed above, there is no current diagnosis of myalgia and myositis. As a result, the Board finds that the preponderance of the evidence is against the claim. Gilbert, 1 Vet. App. at 53. As such, service connection for myalgia and myositis must be denied. 6. Service connection for sinusitis. The Veteran claims entitlement to service connection for a sinusitis disability. The Board remanded the claim for further development in a May 2018. In June 2021, the Veteran indicated that she did not want to report to a compensation and pension examination and requested the evaluation based on evidence of record only. As stated above, when entitlement or continued entitlement to a benefit cannot be established or confirmed without a current VA examination or reexamination, VA regulations require specific action to be taken in accordance with 38 C.F.R. § 3.655 (b) as appropriate. 38 C.F.R. § 3.655 (a). Paragraph (b) specifies that when a claimant fails to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. 38 C.F.R. § 3.655 (b). Thus, the claim will be evaluated based on the evidence of record. The Veteran's service treatment records show sinusitis as a listed condition during active-duty service. See October 2007 Service Treatment Records The Veteran's post-service treatment records show complaint of swollen nasal passages and erythematous pain to palpation over the maxillary sinuses, as well as sinus pressure. See March 2014 VA Treatment Records. In January 2019, the Veteran reported that she did not feel well due to a sinus infection. See VA Treatment Records dated January 2019. A July 2021 treatment record shows a diagnosis of "viral URI", sinusitis, with a high temperature and congestion. A March 2021 treatment record reflects a complaint of sinus congestion with fever. However, the record does not show, and no examiner has provided a nexus opinion that the Veteran has a current sinusitis disability related to service. Indeed, the first post-service diagnosis of sinusitis appeared in July 2021 while the Veteran was observed to have a viral respiratory infection. The Board finds there is no competent evidence that sinusitis may be related to service. Therefore, as there is no competent evidence linking a sinusitis disability to service, the Board finds that the preponderance of the evidence is against the claim and the claim must be denied on a direct basis. Gilbert, 1 Vet. App. at 53. 7. Service connection for vaginitis candida albicans. The Veteran claims entitlement to service connection for a vaginitis candida albicans disability. The Board remanded the claim for further development in a May 2018. In June 2021, the Veteran indicated that she did not want to report to a compensation and pension examination and requested the evaluation based on evidence of record only. As stated above, when entitlement or continued entitlement to a benefit cannot be established or confirmed without a current VA examination or reexamination, VA regulations require specific action to be taken in accordance with 38 C.F.R. § 3.655 (b) as appropriate. 38 C.F.R. § 3.655 (a). Paragraph (b) specifies that when a claimant fails to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. 38 C.F.R. § 3.655 (b). Thus, the claim will be evaluated based on the evidence of record. The Veteran's service treatment records show vaginitis candida albicans as a listed condition during active-duty service. See October 2007 Service Treatment Records. A September 2009 treatment record shows diagnosis of "URI" with instructions to use Diflucan medication if a yeast infection develops. The Veteran's post-service treatment records also show multiple complaints of yeast infections, beginning September 2011. See also May 2014 VA Treatment Records. Additionally, a January 2019 VA treatment record shows treatment plan for a "fungal infection" after complaint of a yeast infection. However, the record does not show, and no examiner has provided a nexus opinion that the Veteran has a current vaginitis candida albicans disability related to service. The Board finds there is no competent evidence that vaginitis candida albicans may be related to service. Therefore, as there is no competent evidence linking a currently diagnosed vaginitis candida albicans disability to service. As a result, the Board finds that the preponderance of the evidence is against the claim and the claim must be denied on a direct basis. Gilbert, 1 Vet. App. at 53. 8. Service connection for migraine headaches. The Veteran claims entitlement to service connection for a migraine disability. The Board remanded the claim for further development in a May 2018. The Veteran was afforded a VA examination in March 2019. While the examiner opined that the Veteran's headaches were less likely than not incurred in our caused by service, the examiner also acknowledge that the Veteran's headaches "may have preceded her military enlistment but became worse during her tours". Further, the examiner associated the occurrence of worsening cephalgia to possibly being related to the Veteran's PTSD/MST. The Board notes that the Veteran is considered to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable evidence demonstrates that an injury or a disease existed before acceptance and enrollment and was not aggravated by that service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304. Since no migraine disability was identified at service, the Veteran was presumed sound at entry. The Board has not found that there is clear and unmistakable evidence that the Veteran had a migraine disability that existed prior to service, the presumption of soundness has not been rebutted. Indeed, a July 2001 service treatment note upon entry documents that the Veteran did not have headaches. Subsequently, the Veteran's service treatment records show treatment for a migraine headache disability. See February 2004 Service Treatment Record. As discussed above, there is competent evidence linking a currently diagnosed migraine disability to service. Because the weight of the evidence shows that a migraine was incurred in service and have continued since service, resolving the benefit of the doubt in favor of the Veteran, the Board finds that service connection for a migraine disability is warranted. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Booker The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.